Are key affected women and girls marginalised at Women Deliver 2013?

Bobby Ramakant - CNS
Women Deliver 2013 is re-energizing the global response to issues of women and girls but has it adequately addressed issues that are unique to the most marginalized women and girls? Supporters of Unzip the Lips feel that Women Deliver did not adequately address issues of HIV and key affected women and girls. CNS speaks with advocates of the Unzip the Lips on what some of these issues are. Who are key affected women and girls? The Unzip the Lips campaign defines key affected women and girls in the concentrated epidemic in Asia and the Pacific as including women and girls who are living with HIV, female sex workers, women and girls who use drugs, transgender women and girls, mobile and migrant women, female prisoners, women with disabilities, women in HIV sero-discordant relationships, as well as intimate female partners of men who engage in behaviours that put them at a higher risk of HIV infection.
"Issues related to sex workers will continue to be missed unless we begin recognizing sex work is work and that it is one of the key affected populations in the response. There are innumerable barriers to sex workers accessing to treatment and care services for sexual and reproductive health and HIV. There remains a very high level of stigma against sex-work and discrimination persists within healthcare settings. Sex workers are still looked down upon " said Selvi, a board member of the Asia Pacific Network of Sex Workers (APNSW) which is a supporter of Unzip the Lips.

Selvi added: "Culture and religion are not supporting condom provision for young girls and women, and that is one major impediment in our response. It is important to talk about condoms with women and young girls and educate them about sexual and reproductive health and rights (SRHR). I am shocked at the outcome of not talking about SRHR to young girls and women whenever I visit the clinics and find 18-19 years sex workers becoming HIV positive. One can just wish they had known about SRHR and therefore better equipped against risks of HIV infection. Schools can teach age-sensitive SRHR but countries have failed to take this issue up. That is why we emphasize that it is very important to communicate sexual and reproductive health needs as a right - and refer to it as SRHR. For instance, the misconception that providing condoms will encourage sex among young girls and women is far from reality. We need to enable choices and debunk these misconceptions and empower young girls and women to protect themselves from unintended pregnancies and STIs including HIV."

Despite US FDA approving female condoms 20 years ago, women in need of options to protect themselves from unintended pregnancies or STIs (including HIV) are yet to have access to them. "Sex workers are not aware of female condoms. We educate them about safe sex. We train those, who have never used a condom on how to use and negotiate the use of condoms. In Malaysia, HIV rates among sex workers are coming down but rising among housewives. That is why we insist that education about SRHR should begin from school onwards. When I visit schools to talk about HIV, students come to me with questions about their SRHR needs. Schools have counsellors but students perhaps do not trust them enough as counsellors inform the students’ families as per the school policy. We need to change such policies so that young girls and boys can seek help safely and in confidence."

Violence is a major issue in spotlight at Women Deliver 2013. But violence faced by sex workers/ marginalized women and girls is often more grave and, more often than not, goes unreported. Agreed Selvi: "Sex workers face a lot of violence and abuse perpetrated by the partners, boyfriends, husbands, government, police or other authorities. Sex work often happens underground and sex workers are at risk of even getting killed. That is why we are asking for a safe place for Sex workers. In some countries sex work is not allowed. That is a form of violence also because it drives populations underground and blinds national programmes to conveniently ignore most at risk key affected women and girls. I have a friend who was a differently-abled transgender sex worker (could not talk or hear) who was also HIV positive. She was killed when forcibly drowned in a small river. This is violence."

Transgender women and girls are not only physically abused but they are also confronted with high levels of emotional trauma. Violence faced by transgender women and girls must be addressed along with their sexual and reproductive health and rights (SRHR) needs.

Norlela, President of 'Persatuan Wahidayah (Pewahim)', a network of women living with HIV that supports Unzip the Lips campaign, strongly advocates for the unique needs of women and girls living with HIV and gender sensitive interventions to address them. That is why she had to come forward to form the first network and shelter home for women living with HIV in Malaysia.

Norlela said: "Violence is a major issue faced not only by sex workers but also by wives. Women especially if they are married are at a higher risk of violence. In my shelter home there is a woman who is 23 years old. She was married to a HIV negative man. She was battered, humiliated, reminded of her history of becoming HIV positive and abused in many ways by husband. Her mother-in-law was also involved in this extreme violence she was forced to face. She was clearly not aware of her rights. Her husband had threatened her that if she files for a divorce she will not get the child. So she ran away and came to our shelter. We at the shelter home take care of her health. When she heals and is willing to discuss then we will speak with her if she wants to continue the marriage or dissolve it. There are limitations under Sharia Law in Malaysia and we need to find solutions for her based upon her own decision. We must act upon and do all what is possible to protect rights of all women and girls including the most marginalized ones, rights to ARV for women living with HIV, right to her own space, her right to get education, or her right to live normal with human dignity as anyone else."

At the Women Deliver Conference 2013, the Unzip The Lips issued a call to delegates to strengthen all laws and policies to protect the human rights of key affected women and girls, including women and girls living with HIV. This requires, among others, making safe abortion services and the full range of contraceptive options available for positive women and all other women in need, and ensuring an enabling environment by decriminalizing drug use, same-sex behaviour and relationships, transmission of HIV, and all forms of se work. Stigma and discrimination in healthcare settings against key affected women and girls needs to be addressed, including by ending compulsory HIV testing, forced sterilization, and forced abortion that often target these communities.

RD Marte from the Asia Pacific Council of AIDS Service Organizations (APCASO) is another supporter of the Unzip The Lips campaign. RD said: "In Asia and the Pacific where there is a concentrated HIV epidemic – where to be effective the HIV response needs to focus among specific groups of which mainly are men, the issues and needs of women and girls within these groups are often overlooked.

The “know your evidence, know your response” principle is, rightly, what should guide HIV programming. While the region’s evidence points to the highest levels of infection among specific communities of which most are men, we cannot ignore the fact that women, transgender people and men within the same key affected community experience their situations differently. Despite this, it is still challenging to assert for more gendered HIV responses in this region. There is a great need to ensure that key affected women and girls do not get left out in HIV responses. There is a great need to ensure that the voices of key affected women and girls’ are heard and made to count in the setting of the region’s HIV agenda.

Speaking about how to take forward the gains made by the Unzip The Lips campaign over the past two years and at Women Deliver 2013, RD Marte said: "Unzip has gained significant ground in raising the issues of key affected women and girls in key platforms. At the forthcoming 11th International AIDS Congress in Asia and the Pacific (ICAAP), Unzip will continue to mobilise. We are working with a committed group that wants to make sure key affected women and girls are able to claim and meaningfully use their legitimate space as a community at the ICAAP 11."

Rose Koenders from Asia Pacific Alliance for Sexual and Reproductive Health and Rights (APA) said that: "The Women Deliver conference is a great platform for ensuring that the health and rights of girls and women remain top priorities, and we hope that with our Call the issues of HIV and key affected women and girls and their SRHR will not be left out or forgotten when investing in women and girls”.

Alexandra Johns, Advocacy and Communications Officer at APA and part of Unzip the Lips campaign, highlighted an important issue: resources. "The Unzip The Lips campaign was galvanized in 2011 to provide a voice to key affected women and girls and safe space for them to talk about their needs. A growing number of networks, organizations and individuals have endorsed the campaign since then such as APA, APCASO, Asia Pacific Resource and Research Centre for Women (ARROW), Coalition of Asia Pacific Regional Networks on HIV/AIDS (7 Sisters), Coordination of Action Research on AIDS and Mobility (CARAM Asia), Positive Women Inc, Supporting Community Development Initiatives (SCDI), Women of Asia Pacific Plus (WAP+), Asia Pacific Network of People living with HIV (APN+). We are at a point now where we do need to continue propelling the momentum and in order to do that we need more resources for key affected women and girls, leadership training, and other such initiatives that are critical in order to take the issues and the campaign forward."

The theme of Women Deliver 2013 is "Time to Deliver." Unzip the Lips reminds us that key affected women and girls have been delivering in Asia and the Pacific- as leaders and members of communities who, through the decades, have been at the forefront of HIV advocacy, activism, framework setting, as well as service delivery. It is time for rest of the world to deliver for them.